NPI | 1508220930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MS AT0743) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1654) |
Enumeration Date | 2016-04-12 |
Last Update Date | 2016-04-12 |